Riley doctor Adam Hill knows the pain that substance use issues and mental health concerns can bring with them. He's now decided to help others with similar concerns.
This article appeared at indystar.com
On that autumn day, Adam Hill told his wife he was headed to the lab. But instead of going to the university where he was training, the young doctor drove to a nearby state park, walked deep into the woods, settled under a canopy of ash trees and tried to drink himself to death.
For months, Hill had tried to drown the dissatisfaction with his life in alcohol. He hated his job in medicine. Medical school tuition had left him in debt. His marriage was fraying. The depression with which he had grappled since medical school had returned, darker than ever. He saw no way forward.
“I was just done,” he said. “I was just broken and exhausted and didn’t see a way out.”
That Friday he sat in the woods and drank, hoping to enter eternal oblivion.
But as night fell, he called his wife, Lauren. At first, he refused to speak. They sat on the phone in silence until eventually, Adam told Lauren where to find him. She drove out and brought him home. The next day he entered counseling.
For several years he kept his struggles to himself, not wanting to advertise what others in medicine might view as weakness.
About a year ago, the silence ended. In front of his colleagues at Riley Hospital for Children at IU Health, Hill presented a lecture about a case he knew well — his own.
In March, he shared his path to recovery even more publically, writing a first-person account in the prestigious New England Journal of Medicine.
In that article, Hill called upon his profession to engage in a culture change. Rather than stigmatizing doctors who face mental health, addiction and other challenges, Hill said, he’d like medicine to find a way to provide the support and help these individuals need to become productive, safe physicians.
“What we fail to show people — and we fail because nobody talks about this — are positive role models. I’m not saying I’m not flawed and human, but I have succeeded in my recovery. So I want people to know that there’s hope,” Hill said.
Depression, burnout and suicide occur at higher rates in the medical profession than in many other fields, experts note. Each year about 400 physicians take their own lives, a rate more than twice that of the general population, according to the National Academy of Medicine. Nearly one in three doctors is clinically depressed.
While it’s hard to track these trends, many think the rate is rising as pressures on doctors increase, said Dr. Darrell Kirch, president and chief executive of the Association of American Medical Colleges. Evidence suggests the problem has ramifications beyond the doctors themselves, he added. Physicians who are burned out may not deliver as high quality of care.
The profession has taken note. Last year the National Academy of Medicine convened an initiative that Kirch is leading to explore ways to improve clinician well-being. Many medical centers, including Indiana University Health, now have a physician wellness task force to offer help and support.
“There is a national groundswell of concern about this problem,” Kirch said, adding that Hill’s paper was “a very compelling and elegant statement of the problem.”
“I would say it’s not only ground-breaking, it’s very informative because of the steps that he lays out that we need to approach,” he said. “It’s not just his story, it’s a road map for how the profession needs to work on these things.”
Part of the problem, said Hill, is that doctors stigmatize mental illness and treat it differently than they do physical frailties. In the article he wrote, he contrasts the way doctors talk about colleagues who have cancer with those who have mental illness. A doctor would never say a fellow physician was not tough enough to beat cancer. But he said he heard a doctor saying of a mutual colleague who committed suicide, “I always worried she was not strong enough to be a doctor.”
State medical boards don’t monitor physicians with physical diseases, such as anemia or hypertension, but they do doctors who have mental health or substance abuse problems. This further stigmatizes those individuals and may lead them to avoid getting the treatment they need, Hill said.
A study by a University of Michigan researcher found that 6 percent of doctors who were diagnosed with depression had reported it to their state medical board. Most said they failed to report because they felt it did not affect the care they gave their patients and because of the stigma. The results suggest that the current system is not the best way to identify doctors who need help, said Dr. Katherine Gold, an assistant professor in the University of Michigan’s Department of Family Medicine.
“There’s no better way to prevent people from getting help than to tie that to their licensing and job,” she said in a phone interview.
An ‘Intensive Clinical Experience’
A Vincennes native, Hill had medicine on his mind since middle school. The 2003 Butler University graduate majored in psychology and chemistry and spent his Friday nights volunteering at Riley. From the beginning, children with chronic medical illnesses and cancer captured his heart — and he theirs. Some young doctors master complex procedures, some memorize a dictionary full of symptoms. Hill learned his gift lay in helping patients and their families emotionally navigate intense suffering.
“I always loved working with families that seemed to be in the most difficult times of their lives. I was just always good at sitting with people and being with them in difficult times,” said Hill, who is a pediatric palliative care physician, caring for patients with terminal or severe chronic conditions.
Indiana University School of Medicine allowed him to further hone this skill, particularly the rotations he did at Riley. There he met a patient named Zoe who was awaiting a bone marrow transplant. Hill forged a relationship with her, bonding over their shared love of Thomas the Tank Engine.
Zoe wasn’t always a fan of the doctors who cared for her, often fearing them, recalled her mother, Tish Crook. Hill was different.
“He just had a great way with her. …. He just took the time to talk to her and myself as well,” she recalled a decade later. “When he would come in, she just had this little smile on her face. She was always excited to see him.”
Knowing how much Zoe loved Thomas, Hill brought some trains to her hospital room. Often, she would climb out of bed to play with the train table he gave her.
Zoe died at the age of 3, about six months after her transplant. She was buried holding one of the trains that Hill gave her.
Even in medical school, Hill faced mental health challenges. An excellent student in college, Hill had trouble adjusting to the more competitive, stressful environment. As Hill entered his third year, he broke his leg playing basketball. Time off was not an option, so Hill spent his first two months working in the hospital on crutches and spiraled into depression.
Soon, he sought help, went on medication and entered counseling. The combination worked. He finished medical school, entered a pediatric residency in St. Louis, where he met Lauren. Hill was doing so well he stopped taking anti-depressants. He and Lauren married just before he entered a prestigious, three-year training program as a fellow in pediatric hematology-oncology at Duke University.
Fellows were expected to be on call 24/7 in what’s known as “an intensive clinical experience.”
During his residency, Hill could not work more than 80 hours a week. No such restrictions applied to fellows, who could be on call from home but had to be prepared to field calls from throughout the U.S., even Europe. During one period, Hill slept three hours in three days.
Then, he fell asleep while driving and totaled his car. After that, the program tweaked the schedule so fellows had at least one day off a week. But the overriding culture did not change.
“I knew that what I was doing in terms of academic medicine and the strains that were being put on me was incredibly abnormal. And I hated it. But … my colleagues were doing the same thing,” he said. “The philosophy was always, first year sucks, deal with it and it will be better when you get done. A lot of us held onto that, if you just grind through, a rainbow will appear.”
The second year of his fellowship delivered no rainbows. Instead, it brought work in the lab, neither Hill’s strong suit nor his calling. He went back on anti-depressants, but the pharmaceuticals did not touch the greater void he felt.
Each night he drank. In retrospect, Hill said, he never had had a healthy relationship with alcohol. In college, he rarely indulged, but when he did, he would down five or six drinks at a time.
Now, vodka offered the only escape.
“It was like a light switch for me. Things were racing around in my head, people telling me I wasn’t good enough, I wasn’t working hard enough,” he said.
When Lauren noticed his habit, he started drinking in secret, waiting until she went to bed or slipping into the bathroom or closet. Lauren noticed that on nights when he was on call or working — Hill never indulged when he was responsible for patient care — he seemed particularly unhappy. You need help, she said.
Hill didn’t listen even as suicidal thoughts flitted into his mind. He visited a gun store and handled a few before he dismissed the idea of shooting himself.
About a week later, though, he drove to the park, bottle by his side, planning not to walk out. Over the next eight hours, something changed, something he can’t explain to this day. Without even realizing it, he reached out to his wife for help.
“I always felt like the woods were a peaceful escape for me, somewhere off the routine path, a place to get lost,” he said. “That’s where I found myself.”
A return to the person he was
Lauren insisted he seek treatment. He entered Alcoholics Anonymous and started seeing a psychologist and an addiction counselor. After a relapse, he sought in-patient treatment.
Alcohol has ruined many a marriage, but Lauren refused to give up on him even though his personality changed whenever he drank.
“I just wanted my husband back,” she said. “I had my moments when I wasn’t sure we were going to get through it.”
Hill stayed sober for two years. In 2013, he planned to move to Indiana for a job as a pediatric palliative care physician. A negative reference put this plan on hold. Hill took a temporary job in Oklahoma, miles from his family.
There, he had another relapse, again when not at work. He self-reported his relapse to the Indiana State Medical Association, which mandated another six weeks of inpatient treatment. After completing another fellowship at Riley, he joined the hospital’s staff in 2015.
Dr. Paul Haut, the hospital’s chief medical officer, has known Hill since he was a standout medical student and had served as his mentor. He said he was surprised to learn about Hill’s struggles, but that did not change his view of him. The hospital handles each episode of a staffer who faces such challenges individually, he said.
“I don’t think we take this lightly. We review each case if it’s someone struggling with addiction or mental health issues,” he said.
For a while, Hill kept his experiences to himself. But he started to speak out. He had known at least one person at every step of his training who committed suicide.
Many factors contribute, especially for those in the early part of their training, Hill said. The work environment can be toxic and exhausting. Both patients and physicians may expect perfection, but mistakes happen and people will die, often through no fault of the doctor.
“I have seen doctors walk out of rooms where patients die and they say, ‘It was my fault,’ in situations where the medical care was flawless. We can’t prevent death, and we’re arrogant to feel like we can,” Hill said. “Yet we have hospital billboards across the country that say ‘change the outcome’ or ‘expect a miracle.’ That’s just not realistic. … Some things are out of our control even if we do our best, and we don’t allow people to accept that in our culture.”
Eventually, Hill reached a point in his recovery where he made peace with his past. Last August, Hill delivered the lecture about his experience with mental illness, addiction and recovery. The month before, the Indiana University School of Medicine community had seen two suicides, one a former faculty member and the other a student.
“I felt empowered that I needed to say something to try to help people that were suffering in silence,” he said. “I just felt it was the right time to say something.”
The father of newborn daughter Zoe and a toddler son Grayson, Hill has found joy in his home life and his work. Each day he seems to come more and more alive, Lauren said, transforming from the shell of a person he was to an even better version of the man with whom she fell in love.
While some might find Hill’s specialty of pediatric palliative care depressing, Hill credits the work he does every day with being essential to his recovery. Some of his patients live with chronic diseases, others have terminal ones, but all face intense physical challenges.
“To be honest, it’s partially what helped save my life, transitioning into this work, because there’s a greater meaning and purpose to this work. You can have a profound impact and be able to help people on a daily basis at their toughest time. If we can make a difference and make someone’s moments or days better while they’re here, it’s worth it.”